Cutaneous mastocytosis in human immunodeficiency virus: an unfortunate coincidence?

Urticaria pigmentosa in a patient with acquired immunodeficiency syndrome – a case report / Urtikarija pigmentoza kod obolelog od sindroma stečene imunodeficijencije – prikaz slučaja

The authors present a case of a man with urticaria pigmentosa and acquired immunodeficiency syndrome - AIDS. The patient was diagnosed as HIV (human immunodeficiency virus) - positive in the year 2000, at the Infectious Diseases Clinic, Clinical Center of Vojvodina in Novi Sad. Urticaria pigmentosa was detected (nine years later) during a dermatological examination at the Dermatovenerology Department of the Outpatient Clinic, Clinical Center of Vojvodina. Urticaria pigmentosa is the most common manifestation of cutaneous mastocytosis. The patient was taking long term antiviral therapy for several years. Approximately 2 years after the onset of urticaria pigmentosa, this patient developed septicemia and ascites along with hepatosplenomegaly, liver damage, chronic cholecystitis, leukopenia, thrombocytopenia and relative eosinophilia. The patient had increased total serum IgE levels and tested positive for 5-hydroxyindoleacetic acid in a 24-hour urine test from the very beginning of urticaria pigmnentosa and during the course of his illness. Immunohistochemical results of dermal biopsy of the affected area confirmed the diagnosis of urticaria pigmentosa. Histology findings confirmed presence of typical dermal mast cell infiltrates with distinct oval and spindle granules that were CD117+ and CD1a-. Systemic mastocytosis was excluded by liver and bone marrow biopsies. To our knowledge, we present the third case of associated mastocytosis and acquired immunodeficiency syndrome published in world literature so far, in order to indicate the possible interaction between HIV infection and mast cells.